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Senior Analyst, Edits | Payment Integrity (Remote)
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Job Description
- Req#: J0126-0518
Employer Industry: Healthcare Analytics and Consulting
Why consider this job opportunity:
- Salary up to $100,000.00
- Comprehensive insurance options and competitive compensation
- Matching contributions through the 401(k) plan and share purchase plan
- Paid time off for vacation, holidays, and sick time, along with paid parental leave
- Access to learning opportunities and tuition assistance
- Opportunity to work for one of the largest IT and business consulting services firms in the world
What to Expect (Job Responsibilities):
- Identify high-impact edit opportunities through claim data analysis
- Translate medical policy and coding guidance into actionable logic for edit development
- Design validation datasets and lead pre-deployment user acceptance testing (UAT)
- Monitor performance metrics, including yield and ROI, for continuous improvement
- Collaborate with stakeholders to align on strategy and present performance dashboards
What is Required (Qualifications):
- Active coding certification (CCS or CPC) with deep clinical coding expertise
- Minimum of 5 years of experience in payment integrity, claims analytics, medical policy, or coding
- Deep knowledge of CPT/HCPCS, ICD-10, DRG, APC/OPPS, and NCCI bundling policies
- Proven experience in prepay editing or post-pay audit logic
- Bachelor's degree in Business, Healthcare, Data Analytics, Public Health, or a related field (or equivalent experience)
How to Stand Out (Preferred Qualifications):
- Proficiency in SQL and experience with claims rules platforms (e.g., Optum/CES, Cotiviti, McKesson)
- Current RN licensure
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